ABSTRACT
Background: COVID-19 infection and Multisystem Inflammatory Syndrome in Children (MIS-C) in hospitalized pediatric patients have been associated with cardiac manifestations . Generally, children have asymptomatic or mild COVID-19 infection and MISC is rare. We examined the cardiac implications of asymptomatic or mild COVID-19 infection in non-hospitalized children to better define this outcome. Methods: We queried the electronic medical record for patients ≤18 years-old referred for outpatient pediatric cardiology evaluation following COVID-19 infection from 5/1/2020 - 4/30/2021. We excluded patients without a confirmatory COVID test (PCR or serology), who had been hospitalized for any condition related to COVID-19 (including MIS-C), or with history of cardiac disease that could affect coronary artery dimension. We recorded electrocardiogram (EKG) and echocardiogram (ECHO) findings, and laboratory studies performed during a preceding emergency department or most recent cardiology clinic visit. Results: Of 277 records reviewed, 134 met inclusion criteria (Figure 1);mean age 9.6 +/- 5.4 years, 53% male. 131 patients had a normal or minor variant on EKG and ECHO (Table 1). Three patients had coronary artery (CA) abnormalities on ECHO: 1) 7-year-old male with history of mild COVID-19 infection;borderline left main CA dilation (Z-score +2.1 on largest measurement). Plan for close follow-up and repeat ECHO. 2) 16-year-old male with positive COVID serology;dilated right CA (Z-score +2.3);started on aspirin. Plan for close follow-up, repeat ECHO, and possible CT angiography. 3) 8-yearold male with history of mild COVID-19 infection;dilated left main CA (Z-score +2.6);started on aspirin;CT angiography confirmed enlarged left main CA. Plan for close follow-up and repeat ECHO. Prior to COVID-19 this patient had an ECHO with normal CA dimensions (Z-score -0.4). Conclusion: While cardiac disease in children with COVID-19 infection is uncommon, we report three pediatric patients who may have developed CA dilation following confirmed mild or asymptomatic COVID-19 infection. Current return to play guidelines recommend cardiology evaluation after moderate to severe COVID-19 infection, as studies have reported myocarditis in young healthy athletes. Our study adds to the body of literature on COVIDrelated cardiac disease and may have important implications for post-COVID surveillance in young healthy children following minimal illness. Data collection is ongoing.
ABSTRACT
Purpose : To evaluate the risks and impact of COVID-19, SARS-CoV-2, on a private ophthalmology practice in Ohio and analyze the fluctuation in patient visits and surgeries before and during the COVID-19 pandemic. Methods : A retrospective analysis was performed using outpatient clinic logs for patients seen during the first 10 weeks of 2020 and compared to outpatient clinic logs for 10 weeks during the COVID-19 pandemic. During the twenty-week period, the number of appointments, intravitreal injections, and surgeries, most commonly retinal detachments, epiretinal membrane (ERM), and vitreous hemorrhages, were compared. Additionally, consideration was given to potential measures to reduce the spread and maintain prepandemic clinical care levels. The number of appointments, injections administered, and surgeries completed or postponed were analyzed before and during the COVID-19 pandemic. The practice implemented additional precautions for patients and staff. These included, but were not limited to, temperature checks, hand sanitizer availability, required use of face masks, and asking patients to come alone to appointments;with the exception of patients that were wheelchair bound, suffered from dementia, were under the age of 18, or required a translator. Results : During the first 10 weeks of 2020, the practice saw an average of 2,205 visits a week. In week one of the pandemic, the average was 1,147 patients per week, a 54% drop. An overall 40% drop was seen in surgical cases;vitreous hemorrhage surgeries decreased by 35%, retinal detachment surgeries decreased 25%, and ERM peels reduced by 60%. The drop in ERM's were mostly due to rescheduling. Intravitreal injections during the first 10 weeks averaged 1,025 (SD±112) per week. During the start of the 10 COVID-19 weeks, intravitreal injections averaged 852 (SD±122) per week and by the last weeks injections averaged 972 (SD±142) per week. Conclusions : In the early stages, the initial number of outpatient visits declined by 54%, the average number of intravitreal injections did not change in a similar pattern. This represents the importance of patients' triage and prioritizing urgent cases.